RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04792
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E2, Signal Support Systems Specialist, medically separated for “left hip stress fracture of the inferior pubic ramus” with a disability rating of 0%.

CI CONTENTION:  “I had to have a hysterectomy and cannot have any more children.  The pain around my groin area is so bad sometimes that I cannot kneel, bend, walk, etc.” The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20071012	VARD - 20080613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Hip Stress Fracture of the Inferior Pubic Ramus	5022	0%	Status Post Left Hip Fracture 	5022-5003	10%	20080415	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Left Hip Stress Fracture of the Inferior Pubic Ramus.  According to the service treatment record and MEB narrative summary (NARSUM), the CI complained of left hip pain in December 2006.  A bone scan revealed a stress fracture of the left inferior pubic ramus and stress change of the left acetabulum.  A July 2007 X-ray of the left inferior pubic ramus demonstrated healing with normal alignment at the fracture site.  The 14 September 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, revealed decreased left hip range of motion (ROM).  The 27 September 2007 MEB NARSUM examination, 2 weeks later, noted complaints of chronic daily left hip pain, aggravated by activity and prolonged standing or sitting.  Physical examination showed a normal gait and negative straight leg raise test without evidence of muscle atrophy or fasciculation.  Strength in the lower extremities was 5/5 and there was no tenderness over the greater trochanter.  The ROM study by physical therapy showed left hip extension of 10 degrees (normal 20), flexion of 105 degrees (normal 125), abduction of 28 degrees (normal 45), adduction of 12 degrees (normal 25), external rotation of 42 degrees (normal 45) and internal rotation of 38 degrees (normal 40).  There was pain with flexion, abduction and adduction.  

At the 15 April 2008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported intermittent left hip pain.  Physical examination showed an extension of 18 degrees, flexion of 105 degrees, abduction of 20 degrees, adduction of 18 degrees, external rotation of 28 degrees and internal rotation or 24 degrees.  There was pain with extension, flexion and internal rotation. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hip condition 0%, coded 5022 (periostitis), citing ROM limited by pain.  The VA rated the left hip condition 10%, dual coded 5022-5003 (periostitis-arthritis, degenerative), based on the C&P examination, citing painful or limited motion of a major joint.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5251 or 5252).  There was no limitation of abduction, adduction or rotation that supported a rating under the VASRD diagnostic codes for limitation of motion (5253).  There was no hip flail joint that supported a rating under the VASRD diagnostic code (5254).  However, there was evidence of slight hip disability to justify a 10% under code 5255 (femur, impairment of).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left hip condition, coded 5255.  

BOARD FINDINGS:  In the matter of the left hip condition, the panel recommends a disability rating of 10%, coded 5255 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Hip Stress Fracture of the Inferior Pubic Ramus	5255	10%	

The following documentary evidence was considered:  

 [AR NUMBER],   

Dear XXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Enclosure